Encopresis (faecal incontinence in children)

Question 1

Encopresis is

Answer 1

the involuntary passage of formed or semi-formed stools into clothing

• occurring repeatedly for at least 1 month,
• in children 4 yrs and over.

Inadequate toileting and poor diet are features.

The key feature is significant faecal retention → rectal dilatation.

PR reveals poor anal tone, capacious rectum overload with firm faeces.

Question 2

Assessment

Answer 2

History inc. development

Examination inc. check underwear

Consider abdominal X-ray (serves as baseline)

Question 3

Management

Answer 3

The majority are cured with the following strategies.

The initial task is to empty the bowel of faeces

• (can take months)

Laxative medication:

Stool softener (e.g. paraffin oil) 20–40 mL daily

Macrogol 3350 (Movicol) sachets 1 bd day 1, 2 bd day 2, 3 bd day 3 and so on until desired result

Consider Microlax enema, then Senokot granules, one teaspoon daily

Question 4

If severe faecal impaction:

Answer 4

Admit to hospital (day care)

Consider abdominal X-ray

Macrogel 3350: double usual dosage

Microlax enema

If unsuccessful, sodium phosphate (Fleet) enema (not <2 y)

If oral medication refused, sodium sulphate (ColonLYTLEY) via nasogastric tube.

Question 5

General care:

Answer 5

Ongoing interest and support (critical)

Education and counselling

A good normal diet, adequate fluids and exercise

Structured toileting program (e.g. regular sitting on toilet for at least 10 mins, 3 times/d after each meal)

Regular follow-up with encouragement, e.g. star-chart diary

Avoid punitive methods, criticism and undue focus on the problem

Consider encopresis clinic if problematic